Breastfeeding an older baby whilst experiencing

Hyperemesis

The information on this sheet is based upon my professional experience as a pharmacist with a specialised
interest in the safety of drugs in breastmilk, supported by evidence from expert sources. However, I cannot take
responsibility for the prescription of medication which remains with the healthcare professionals involved. I am
happy to discuss the evidence by email wendy@breastfeeding-and-medication.co.uk

Many more women are now breastfeeding their babies for longer and may still be
feeding when they fall pregnant. For those who suffer from hyperemesis this is a
tough time. Sadly some healthcare professionals do not understand that there is
benefit to a child from being breastfed to the age of two years and beyond (WHO)
alongside a normal weaning diet. Being asked to abruptly wean your older child in
order to take medication is not an easy option and is not necessary. Sometimes
sitting quietly to breastfeed whilst you fight the feeling of nausea is essential.

In this fact sheet I have provided links to detailed information on the medication
which can help prescribers to reach an evidence based decision on the safety of the
drug to the breastfeeding baby which is not available in standard reference texts like
the British National Formulary (BNF). The linked pdf files contain information sourced
from LACTMED May 2016

Antihistamines

 Promethazine (Avomine) : May possibly cause some drowsiness in

the nursling but anecdotally appears to happen rarely
PROMETHAZINE.pdf

 Cyclizine (Valoid) : May possibly cause some drowsiness in the nursling but
anecdotally appears to happen rarely

CYCLIZINE.pdf

©Dr Wendy Jones Pharmacist Breastfeeding and Medication

www.breastfeeding-and-medication.co.uk
May 2016
Pyridoxine

Another name for Pyridoxine is vitamin B-6. The recommended daily allowance for non-
pregnant women is 1.6 mg/day. Slightly more is needed during pregnancy and lactation and
most prenatal vitamin supplements contain from 12-25 mg/day. Very high doses (600
mg/day) were reported to decrease production of breastmilk by inhibiting prolactin. [1, 2]
However, this data has been refuted in two studies [3, 4]

It is not advisable to use in excess of 100 mg/day because of the risk of peripheral
neuropathy. One study clearly indicates that pyridoxine readily transfers into breastmilk and
that B-6 levels in milk correlate closely with maternal intake. [5]

1. Marcus RG. Suppression of lactation with high doses of pyridoxine. S Afr Med J 1975;
49(52):2155-2156.

2. Foukas MD. An antilactogenic effect of pyridoxine. J Obstet Gynaecol Br Commonw

1973; 80(8):718-720.

3. de Waal JM, Steyn AF, Harms JH, Slabber CF, Pannall PR. Failure of pyridoxine to
suppress raised serum prolactin levels. S Afr Med J 1978; 53(8):293-294.

4. Canales ES, Soria J, Zarate A, Mason M, Molina M. The influence of pyridoxine on

prolactin secretion and milk production in women. Br J Obstet Gynaecol 1976; 83(5):387-
388.

5. Kang-Yoon SA, Kirksey A, Giacoia G, West K. Vitamin B-6 status of breast-fed neonates:
influence of pyridoxine supplementation on mothers and neonates. Am J Clin Nutr 1992;
56(3):548-55

Prochlorperazine
Low levels of prochlorperazine are secreted into breastmilk and it can be used when
breastfeeding. Side effects for the mother include drowsiness, restlessness and occasional
extra pyramidal effects but babies seem to exhibit no adverse reactions. It is licensed to be
given directly to babies weighing more than 10 kg.

PROCHLORPERAZIN
E.pdf

Ondansetron
This is a powerful anti-sickness tablet used to treat people who have severe sickness when
being treated with chemotherapy for cancer. Little research seems to exist (or have been
published) on use during breastfeeding but anecdotally it is being used with no apparent
adverse effects

ONDANSETRON.pdf

©Dr Wendy Jones Pharmacist Breastfeeding and Medication

www.breastfeeding-and-medication.co.uk
May 2016
Domperidone

Domperidone (Motilium®) has widely been used to increase milk supply in the past.
Concerns were raised by the MHRA in 2014 about use in patients with heart defects, there
has been some reticence by doctors to prescribe it. There are no reports of problems in the
amounts passing through breastmilk www.breastfeedingnetwork.org.uk/wp-
content/dibm/Domperidone%20as%20a%20galactogogue.pdf

Metoclopramide
Metoclopramide has also been used to increase milk supply. It is associated with an
increased risk of depression as well as other side effects if used long term. There are no
reports of problems in the babies from the amount passing through breastmilk.
www.breastfeedingnetwork.org.uk/wp-
content/dibm/Domperidone%20as%20a%20galactogogue.pdf

©Dr Wendy Jones Pharmacist Breastfeeding and Medication

www.breastfeeding-and-medication.co.uk
May 2016